The inspection took place on 23 July 2018 with the registered provider being given short notice of the visit to the office, in line with our current methodology for inspecting domiciliary care agencies. This was the first inspection since the service registered with the CQC in July 2017.

H & S Care & Medical Professionals is a domiciliary care agency which provides personal care to people living in their own houses and flats in the community. At the time of the inspection the service was supporting 13 people with varying needs, this included older people, people living with dementia and children with a learning disability.

The service had a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Most of the people we spoke with told us they were satisfied with the way the service was run. However, they identified some areas they thought could be improved. People said their privacy and dignity was respected and staff were caring and helpful. However, written records did not always reflect the positive aspects of the service people told us about.

Systems were in place to reduce the risk of abuse and to assess and monitor potential risks to individual people. However, guidance on how staff should manage each area of risk was not always as detailed as it could be and appropriate staff training in this topic could not be evidenced.

Recruitment processes to help the employer make safer recruitment decisions when employing staff had been carried out, but documentation was disorganised. Staff told us the registered manager had worked with them to help them understand people’s needs, but documentation did not demonstrate staff had received a structured induction to the company, or timely training in all essential topics.

Staff received regular group support from the registered manager at weekly meetings, but regular one to one sessions had not been incorporated into routine practice. The registered manager had begun to meet with staff on a one to one basis to appraise their work performance and offer support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, there was room to improve the written information in people’s records in relation to their capacity and consent interest. Not all staff had completed training in this topic.

Where possible, people were encouraged to manage their own medication, with some people being supported by relatives. Where assistance was required support was provided by staff. They told us they had completed medication training and their competency in this subject had been checked by the registered manager, but there was no documented evidence to support the latter.

People’s needs had been assessed before their care package commenced and we found they, and/or their relatives, had been involved in these assessments. People told us their needs were being met by staff. However, not all the people we spoke with had a written care plan in their home to inform and guide staff. Where plans were in place they provided information and guidance to staff, which assisted them to deliver the care people needed, in the way they preferred.

The registered manager told us the complaints policy was provided to people using the service along with other information about how the service intended to operate. However, some people said they had not received this information. When people had raised concerns, these had been addressed by the registered manager.

The service had only been supporting people in the community since February 2018, therefore the process for consulting with people a